Social support and ideal cardiovascular health in urban Jamaica: A cross-sectional study

Recent studies have suggested that high levels of social support can encourage better health behaviours and result in improved cardiovascular health. In this study we evaluated the association between social support and ideal cardiovascular health among urban Jamaicans. We conducted a cross-sectional study among urban residents in Jamaica’s south-east health region. Socio-demographic data and information on cigarette smoking, physical activity, dietary practices, blood pressure, body size, cholesterol, and glucose, were collected by trained personnel. The outcome variable, ideal cardiovascular health, was defined as having optimal levels of ≥5 of these characteristics (ICH-5) according to the American Heart Association definitions. Social support exposure variables included number of friends (network size), number of friends willing to provide loans (instrumental support) and number of friends providing advice (informational support). Principal component analysis was used to create a social support score using these three variables. Survey-weighted logistic regression models were used to evaluate the association between ICH-5 and social support score. Analyses included 841 participants (279 males, 562 females) with mean age of 47.6 ± 18.42 years. ICH-5 prevalence was 26.6% (95%CI 22.3, 31.0) with no significant sex difference (male 27.5%, female 25.7%). In sex-specific, multivariable logistic regression models, social support score, was inversely associated with ICH-5 among males (OR 0.67 [95%CI 0.51, 0.89], p = 0.006) but directly associated among females (OR 1.26 [95%CI 1.04, 1.53], p = 0.020) after adjusting for age and community SES. Living in poorer communities was also significantly associated with higher odds of ICH-5 among males, while living communities with high property value was associated with higher odds of ICH among females. In this study, higher level of social support was associated with better cardiovascular health among women, but poorer cardiovascular health among men in urban Jamaica. Further research should explore these associations and identify appropriate interventions to promote cardiovascular health.

Firstly, we will ask you to answer a set of questions to identify stressful factors that you may have experienced, estimate your stress level and the level of support you receive from family, friends or your religious community.Questions will include major events in your life, experiences on the job, feelings about unfair treatment and feelings about your relationships.We will also ask about receiving or giving help to family, friends or your religious community.You have the right to refuse to answer any question, which makes you feel uncomfortable.
Secondly, we will re-measure your blood pressure, height, weight, hip, and waist size.We will also ask you to give a finger prick blood sample to measure blood sugar and cholesterol levels.
Lastly, we will collect information about your community from government or other sources to help us place communities in income categories.This information will be about your community in general and not specific to you.No personal information will be collected.The interview will be conducted in your home or at another convenient location.The entire interview (questionnaire and measurements) should take about forty-five minutes.The finger stick sample will require another five to 10 minutes.We would like to do the finger stick first thing in the morning, before you have eaten, so we will arrange the interview in the early morning or come back another morning to do it.Overall the study will be completed during one or two visits.
Your participation is entirely up to you.You may choose not to participate in the any part of the study or to stop participating if you do not wish to continue, even after you have started.Benefits: There are no definite benefits to you for participating in this study but the research is likely to be beneficial to society, if the findings lead to the introduction of new policies or procedures to improve the nation's health.The tests performed may have some indirect benefits, in that, if we find anything abnormal with you during the study we will refer you to the appropriate health department for further care.Such referral will be made to the public health service, so there would be no associated user fee.If you prefer to be referred to another health care facility, this will be at you own expense.
Risks: There are minimal risks associated with this study.You may experience brief discomfort from the finger stick and some questions may make you feel a bit uncomfortable or cause you to remember unpleasant events.If you feel uncomfortable about any of the questions, the interviewer can skip those Now I will explain the procedure for measuring your pulse and blood pressure.It is important that you remain relaxed and seated for the measurement which will take about 15 minutes.Please do not cross your feet or legs during the measurements.I will wrap the blood pressure cuff around your arm, take your pulse and then inflate the cuff.You will feel a sensation of pressure on your arm when the cuff is inflated.I will be inflating the cuff a maximum of 5 times.While I am measuring your blood pressure, it is best if we do not talk.If you have any questions, I will be happy to answer them for you before or after the measurement is taken.I will tell you the results of the measurements afterward.
1. Have you had any food, alcohol, coffee or cigarettes within the last 30 minutes?

10 .Section 4 : Discrimination 11 . 4 )Psychosocial Stress Questionnaire 1 (
Total Economic Problems (7-item count, ranging 0-7): In the last year, which of the following have you done as a result of economic problems to you and your family: a) Sold possessions or cashed in life insurance to cover day-to-day expenses (soldpossessions) [1] Yes [0] No [99] No response b) Postponed seeing a doctor or other health professional for financial reasons (postponedoctor) [1] Yes [0] No [99] No response c) Been unable to purchase prescribed medications for financial reasons (notbuymeds) [1] Yes [0] No [99] No response d) Borrowed money from friends or relatives to pay for needed everyday expenses (borrowmoney) [1] Yes [0] No [99] No response e) Applied for government assistance through the PATH programme, or other government run social security programmes to help meet everyday expenses (govassistance) [1] Yes [0] No [99] No response f) Obtained a loan to consolidate or pay off debt (loanfordebt) [1] Yes [0] No [99] No response g) Moved to cheaper living quarters or moved in with other people because you could not afford to stay where you were (cheaperhouse) [1] Yes [0] No [99] No response Past-Year Events (4-item count, ranging 0-For each item below indicate if any of the following have occurred within the past year a) Have you ever been unfairly fired from a job or been unfairly denied a promotion?(fire) [1] Yes [0] No [99] No response i.If yes, indicate when this last occurred.(firetime): [1] within the last week [2] within last month [3] within last year variable names in parentheses) ID NO. |___|___|___|___|___|___|___|___|___|___|___|___|___| QUESTIONNAIRE ID NO. [__]__] __] __] Reg Par Con ED Dw H Re Adapted with permission from the Chicago Community Adult Health Study Page 23 of 36 b) Have you ever been unfairly not hired for a job?(nothired) [1] Yes [0] No [99] No response i.If yes, indicate when this last occurred.(nothiretime): [1] within the last week [2] within last month [3] within last year c) Have you ever been unfairly stopped, searched, questioned, physically threatened or abused by police?(policeabuse) [1] Yes [0] No [99] No response i.If yes, indicate when this last occurred.(policeabusetime): [1] within the last week [2] within last month [3] within last year d) Have you ever been unfairly prevented from moving into a neighborhood because the landlord or realtor refused to sell or rent you a house or apt? (housingdiscrim) [1] Yes [0] No [99] No response i.If yes, indicate when this last occurred.(housingdiscrimtime): [1] within the last week [2] within last month [3] within last year 12. Daily Life Discrimination (5-item mean index, ranging 1-5): In your day-to-day life, how often have any of the following things happened to you (reverse coded) Please indicate your answer using the following scale: 5 = at least once a week; 4 = a few times a month; 3 = a few times a year; 2 = less than once a year; 1 = never; 99 = no response a) Treated with less courtesy or respect than other people (discrim1)

Page 5 of 36 From
Jamaica Health and Lifestyle Survey Used with permission PARISH __________________________ What is the name of the area you live in:________________ ┼ Interview Status codes 1. Completed household interviews : assessment of eligibility 2. No individual available for household interview -REVISIT 3. Household interviews completedselected respondent not at home or available -REVISIT 4. Partially completed questionnaire -REVISIT 5. Partially completed questionnaireanthropometry and biomedical measures outstanding 6. Partially completed questionnaire-START TIME OF INTERVIEW-HOUR [__] MINUTES [__] [__] AM/PM END TIME OF INTERVIEW -HOUR [__] MINUTES [__] [__] AM/PM Please circle the correct time of day Cardiovascular Health

KISH TABLE How many eligible persons live in this household? _______ Number PLEASE RECORD THE NAMES AND OTHER PARTICULARS OF ALL ELIGIBLE PERSONS WHO LIVE IN THIS HOUSEHOLD. THIS SHOULD INCLUDE ALL WHO USUALLY EAT AND SLEEP HERE. LIST ALL MALES FIRST, START WITH THE OLDEST MALE MEMBER, THEN THE NEXT OLDEST, THEN All FEMALES SCHEDULE
OF ALL PERSONS LIVING IN HOUSEHOLD * Sex codes 1-Male 2-Female

Don't know 99. No response Cardiovascular Health in Urban Jamaica: Psychosocial Stress, Social Networks and Social Support
___________________________________________________________________ 1.10 What is your primary occupation, that is the job which you spend most time doing?(NB job includes any activity that you do to make money; i.e. your primary source of income.)_______________________________________________________ |__|__| 1.11 Are you self-employed in this occupation?(i.e.job given in 1.10 above) |__|__|

. Don't know/don't remember 99.No response 10.14 Have
you tried to stop smoking tobacco products?0. No (Go to Q 10.16) 1. Yes, no longer smoke 2. Yes, still smoke (

No response Cardiovascular Health in Urban Jamaica: Psychosocial Stress, Social Networks and Social Support
On average how many of the following tobacco products do you smoke and how frequently?(Write the frequency in the table provided)

. Don't know 99. No response 12.2. What
is your main leisure time activity?(

No response Cardiovascular Health in Urban Jamaica: Psychosocial Stress, Social Networks and Social Support
During the last 7 days, on how many days did you do moderate physical activities like carrying light loads, bicycling at a regular pace, doubles tennis?Do not include walking.
Think about all the Vigorous activities that you did in the last 7 days.Vigorous activities refer to activities that take extra physical effort and make you breathe much harder than normal.Think only about those physical activities that you did for at least 10 minutes at a time.12.8During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting, digging, running, basketball, football, tennis, or fast bicycling?|__|__|(a)0. [___] No vigorous physical activities (Go to Q 12.9) 1. ___ days per week (b) How much time did you usually spend doing vigorous physical activities on one of those days?|__|__|___Hoursper day ___ ___ ___ minutes per day 88.Don't know/Not sure 99.No responseThink about all the moderate activities that you did in the last 7 days.Moderate activities refer to activities that take moderate physical effort and make you breathe somewhat harder than normal.Think only about those physical activities that you did for at least 10 minutes at a time.12.9

per day 88. Don't know/Not sure 99. No response
The last question is about the time you spent sitting on weekdays during the last 7 days.Include time spent at work, at home, while doing course work and during leisure time.This may include time spent sitting at a desk, visiting friends, reading, or sitting or lying down to watch television.12.11During the last 7 days, how much time did you spend sitting on a week day?___ Hours per day ___ ___ ___ minutes

per day 88. Don't know/Not sure 99. No response DIETARY PRACTICES
During the past month, how many times per day, week or month did you drink 100% PURE fruit juices?Do not include fruit-flavoured drinks with added sugar or fruit juice you made at home and added sugar to.Only include 100% juice.
These next questions are about the fruits and vegetables you ate or drank during the past 30 days.Please think about all forms of fruits and vegetables including cooked or raw, fresh, frozen or canned.Please think about all meals, snacks, and food consumed at home and away from home.13.6

. Don't know 99. No response 13.12 During
the past month, how many times per day, week, or month did you eat fish for example mackerel, sardine, whole fish, and sliced-fish?

Cardiovascular Health in Urban Jamaica: Psychosocial Stress, Social Networks and Social Support
For each event, please indicate whether the event occurred at any point in your life:

that 1 = disagree strongly ; 4 =agree strongly; 99=no response):
After each statement, please tell me the extent to which you agree or disagree (reverse-coded so My job leaves me feeling too tired and stressed after work to a) Participate in the activities with friends and family that I'd like to (jobconflict1)